Wisconsin's ambulance standards haven't changed in 14 years

Feb. 15, 2013

Paul Schilling, the state's lone ambulance inspector, performs an ambulance inspection at the Oshkosh Fire Department located on Court St. on Jan. 22 in Oshkosh. / Sharon Cekada/The Post-Crescent

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The standards for ambulance quality and equipment haven’t been significantly updated for 14 years, even though they’re used as a yardstick when a state inspector visits the 1,200 ambulances carrying patients in Wisconsin.

The result, emergency medicine providers say, is that their departments are forced to keep buying equipment that’s less useful for patients or more expensive than other options.

“Fourteen years is a long time without change, especially in the medical field,” Jim Austad, a battalion chief for the Oshkosh Fire Department and a member of Wisconsin’s EMS Advisory Board, said. “Most services are doing the right thing and trying to put updated items on there, but that’s in addition to what the state requires.

“Are all ambulance services taking it upon themselves to put that equipment on there?”

Austad’s question isn’t one the state can answer, though he and state officials believe individual departments do what’s best for their patients. But just checking the 150 items that the state does require takes one inspector two years.

The checklist the inspector uses is based on a portion of the Department of Transportation’s administrative code known as “Trans 309.” The rule spells out exact standards for the vehicles and can take years to change, a hurdle in the constantly changing EMS industry.

Even the methods for treating minor injuries are affected by the logjam. The rule requires ambulances to carry sanitary burn sheets, which expire and have fallen out of favor with some medical associations. A dry dressing or clean cotton sheet can affordably serve the same purpose, keeping air and dirt or dust off a burn, Austad said.

A recent report by the National Highway Traffic Safety Administration recommended one way to make changing state standards easier: by moving inspections and the responsibility for updating ambulance standards from the State Patrol to the Wisconsin EMS Division within the Department of Health Services.

Karen McKeown, administrator of the department’s public health division, said her agency is reviewing the report’s recommendations. A spokeswoman for the Department of Health Services could not provide a time frame.

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State officials charged with setting and enforcing standards for ambulance providers say they’re short on the staff and time to update the chapter. Changing a state rule can take years, including public hearings.

Austad said he understands updating the state rule on ambulances will take time but wants the State Patrol to make it a priority. The state should take the national highway administration’s recommendations seriously because the State Patrol is “too slow to react” to changes in emergency medicine, he said.

In the meantime, individual ambulance providers and private groups have tried to fill the gap between Wisconsin’s requirements and what’s best for patients, especially children.

In 2002, if the Oconomowoc Fire Department received a rare call for a child seizing or choking, paramedics heading to the scene could only guess at what size tubing and wiring the patient would need for help breathing or the right dose of medication. With the child’s anxious family or friends nearby, they had to make an educated guess and scramble to find the right item in drawers, cabinets or a chock-full bag.

Now about 99 percent of Wisconsin’s ambulance companies have a “ped bag,” short for pediatric bag holding equipment beyond the state’s requirements and color-coded by size. Some departments bought the kits on their own, while members of the Wisconsin General Federation Women’s Club raised $600,000 statewide and donated bags to nearby ambulance departments.

Glenn Leidel, deputy fire chief of the Oconomowoc Fire Department, worked with the Wisconsin General Federation Women’s Club in the “ped bag” project’s early days. He seems resigned to working without an update to the state standards, referring to the ambulance equipment rule as one of many challenges in emergency medicine.

“The whole emergency service worker persona is that if we’re presented with a problem, we’re going to find a solution,” Leidel said. “If we can’t fund it, we’ll have a bake sale or have an organization step in and fund it for us.”